Reinstatement of Workers’ Comp Benefits in Pennsylvania

Workers’ Compensation benefits are often on a winding path. While your goal is to get better and get back to work – thus eventually ending benefits when the time comes – your condition might get better, then worse again. Because of this, reinstatement of benefits is often allowed.

Reinstatement can occur after your benefits stop entirely or after they’ve been reduced to partial benefits and you’ve returned to part-time or light-duty work. In most cases, the fact that your condition worsened again to the point that you cannot work will be enough, though cases can be a bit complicated by the facts on the ground. In any case, reinstatement is only for benefits to be turned back on for the original injury; if you suffered a new injury at work, that would be handled under a new claim.

For help reinstating your benefits, call the Certified Pennsylvania Workers’ Compensation Specialists at Cardamone Law today at (267) 651-7945.

When Can Benefits Be Reinstated in Workers’ Comp Cases in Pennsylvania?

When we say “benefits” in the context of reinstatement, we are generally referring to your wage-loss or “indemnity” benefits. Other benefits should issue for your medical care, and they should continue until you no longer need treatment for your original injury. Any additional care should still be covered, even if there is a gap in time between treatments or appointments. When it comes to indemnity benefits for your lost wages, however, they are usually stopped or reduced after you begin to make your way toward recovery, and they can be reinstated if things get worse again.

Reinstatement After Termination or Reduction of Benefits

Usually, reinstatement occurs after either a termination or reduction in benefits. Benefits typically start out as total disability benefits, paying you 2/3 of your average weekly wage from before the accident for as long as you cannot work. These benefits can continue this way for the rest of your life if need be, but most people will want to try to get back to work, at least at partial capacity. When you do get back to work at partial capacity, you can receive 2/3 of the difference between old and new wages as partial disability benefits. Then, if you are able to get back to full-time work at full capacity, your wage-loss benefits will be stopped.

Reinstatement from Partial Disability Status

If you return to work or go down to partial disability benefits, but then your injury gets worse again, you can be reinstated to total disability benefits. This often means providing the court with proof that your injury is worsened or that your condition has reemerged in such a way that you cannot work right now.

Reinstatement After Return to Work

If you are back to work at your full pre-injury wage, you will not be receiving any wage-loss benefits, but you can get benefits reinstated if your injury flares back up. This will involve a similar determination as to your status, given that you could be reinstated back to partial disability benefits or full disability benefits, depending on how bad your condition is.

Partial Disability Limits

In any case, partial disability benefits usually must end after a total of 500 weeks, whether they are consecutive or not. You can get back to total disability benefits as often as you need, but if you have run out of partial disability weeks, reinstatement to partial benefits might be impossible.

How Refusing Work Can Impact Your Ability to Get Reinstated to Benefits

It is vital that any time you are given an opportunity to return to work, you review it with our Pennsylvania Workers’ Compensation lawyers. In many cases, your doctor will approve the return to work, and if you agree that you are ready to return, you may be required to do so or else risk losing your benefits. A refusal to work can also affect your ability to get reinstated.

A 2013 case called Napierski v. WCAB (Scobell Company, Inc.) from the Commonwealth Court highlighted how this might work and what is needed to get reinstatement after you are deemed to have refused work.

Background Facts of Napierski

Claimant was a plumber who injured his left leg on July 28, 1995 when a ditch collapsed. Employer accepted his claim and began paying him temporary total disability benefits. Subsequently, Employer referred Claimant to Expediter- a company that aids employees to return to work. They found Claimant a full-time, sedentary (seated) job with a company called IDI, Inc. working 40 hours per week in telephone customer service. The job was funded by the Employer and paid less than Claimant’s pre-injury average weekly wage. Claimant’s own doctor approved the job.

Claimant began working this job in October 2004, but in March 2005, IDI moved him to a second office and then to a third office in August 2005. The moves were allegedly necessitated by problems in the offices, including heating issues and rodents. When Claimant observed mouse feces in paperwork that had been imported from the second office, he quit immediately, claiming the Employer was “playing games” with him. Employer filed a Petition to Modify and the Workers’ Compensation Judge found the IDI job fell within his physical capacities but became “unavailable” to Claimant in January 2005 when the heat malfunctioned. But, it became “available” once again by August 19, 2005 at the third office location. Thus, the WCJ modified his benefits based on what he could have earned at IDI from August 19, 2005 into the future.

On June 30, 2010, Claimant asked Employer to fund the job for him again so that he could return to work. Employer didn’t respond. He then filed the Reinstatement Petition asking for total disability benefits because the funded employment was no longer available to him.

Commonwealth Court’s Holding

The Commonwealth Court ultimately held that once a claimant has refused an available job in bad faith, his employer’s obligation to show job availability ceases. The claimant “must live with the consequences of [his] decision”, meaning he cannot remedy the situation by “subsequent action” such as attempting to accept the job that was previously offered and declined. Instead, the claimant must show a worsening of his medical condition to be awarded a reinstatement to total disability.

In reaching its conclusion, the Commonwealth Court reviewed the burdens of proof in reinstatement contexts. First, it noted that typically a partially disabled claimant can reinstate to total disability by showing that his earning power is once again adversely affected by his work injury. (Piper v. Ametek-Thermox Instruments, 526, Pa. 25, 33, 584 A.2d 301, 304 (1990)). Yet it noted that a claimant’s burden of proof is different where his benefits have been modified because of his bad faith conduct. (Ward v. Workers’ Compensastion Appeal Board (City of Philadelphia), 966 A.2d 1159, 1162 (Pa Cmwlth. 2009)). The Pennsylvania Supreme Court, in Pitt Ohio Express v. Workers’ Compensation Appeal Board (Wolff), 590 Pa. 99, 912 A.2d 206 (2006), held that a claimant’s bad faith refusal of employment relieves the employer of the need to show that a job continues to be available. The Court reasoned that if a claimant rejects a job in bad faith and then puts the burden on the employer, it would reward bad faith conduct and circumvent the purpose of the Pennsylvania Workers’ Compensation Act.

In a footnote, the Commonwealth Court pointed out something quite significant. That is, before the 1996 amendments to the Pennsylvania Workers’ Compensation Act, an employer could obtain a modification if it could show that suitable employment was made available to the claimant. Once the employer referred claimant to an available job, the burden shifted to the claimant to prove that he followed through on the job referral in good faith. (this modification landscape was pursuant to a case called “Kachinski“) After 1996, employers have most frequently used Labor Market Surveys to establish an earning power- this scheme does NOT require a referral to an actual job, but instead, it is a survey of allegedly available jobs that exist in the local economy where a claimant lives (or was injured) that are allegedly within the claimant’s physical and vocational abilities.

Reinstatement vs. New Workers’ Comp Claims in Pennsylvania

If you have a prior work injury, you should always consult with a lawyer on any new work injuries you receive. If the injury was caused by a new accident – especially if it affected a different part of the body – it will likely be handled as a new claim for a new work injury. Even so, knowing how your previous injury and previous effects on your ability to work might interact with this new injury is important to take into consideration when looking for new work.

In some cases, a fresh injury might be considered a reinjury of the original work injury, making your case a claim for reinstatement of benefits and saving a lot of the initial work that goes into proving an injury was work-related and so on. If the accident was truly a new injury, we would need to go back to square one, but reinstating benefits might be an easier case overall.

Call Our Workers’ Comp Lawyers in Pennsylvania Today

For a free case evaluation, contact Cardamone Law’s Pennsylvania Workers’ Compensation attorneys today at (267) 651-7945.